A Definitive Guide to Workers’ Compensation

Employees get injured at work every single day. In fact, a work-related injury happens almost every seven seconds in the United States.

Though the causes of those injuries vary by industry, they all have one thing in common: they’re eligible for workers’ compensation.

Workers’ comp insurance is the best way to protect both business owners and their employees. However, if you’re not sure how the coverage works, it’s easy to feel confused and overwhelmed.

Here’s what you need to know to make the best decisions for your safety and your business.

Workers’ Compensation Is Necessary for Most Businesses

Believe it or not, most states require businesses to invest in workers’ compensation insurance by law. If you have more than two employees, you’re required to have workers’ comp insurance in place.

If businesses don’t or choose to willfully ignore the coverage requirement, business owners can face costly fines and fees. Worse, if an employee gets injured on the job and the business owner doesn’t have insurance, the employee can sue for the cost of the damages.

Workers’ comp insurance helps reduce the liability risk for employers of all sizes. It also protects employees from high medical bills. Though employers must pay for the coverage, the cost of insurance can pay for itself after the first incident.

The Insurance Is Available Through Most Agencies

For business owners looking to protect their company, your insurance agent is your best resource. You should be able to buy workers’ comp insurance through the same agency that provides your standard business insurance coverage.

If you’re not sure how much coverage you need, speak with your insurance agent as soon as possible. They’ll be able to look at the risks your business faces and the number of employees you have on staff to determine the best coverage for your company.

Keep in mind that you may need to review your coverage and make adjustments throughout the year as your company expands. If, at any point, you think the coverage is inadequate, discuss your concerns with your insurance agent as soon as possible. The sooner you make the necessary updates, the smaller your out-of-pocket expenses will be.

It Protects Employees While They’re Working

Workers’ compensation insurance protects employees from job-related injuries and their associated medical costs. This applies to injuries that happen both at the business and off-site as long as the employee got injured while performing their duties.

If an employee gets injured on their break or while goofing off on-site, the insurance won’t apply. They’ll have to pay the full cost of their medical fees associated with the injury.

However, if the employee gets injured while performing job-related duties, the insurance will cover the cost of the damages. This includes claims resulting from injuries that happen away from the business as long as the employee is acting on behalf of the company.

The Insurance Provides Pay During Recovery

One of the biggest challenges injured employees face is keeping up with their regular expenses while they recover. When they’re not working, they’re not earning money. Without their paycheck, they can’t easily pay their bills and make ends meet.

Every standard workers’ comp insurance plan gives injured employees a portion of their regular paycheck during recovery.

Keep in mind that the amount they receive won’t equal their full paycheck. Typically, employees will receive about 67 percent of their paycheck while on leave. This encourages them to return to work as soon as they’re physically able.

That said, workers’ comp claims are fairly strict. If a doctor doesn’t agree that an employee is ready to return to work, they’re expected to stay at home. Once they receive clearance to go back to work, employers must make reasonable accommodations to aid their continued recovery.

The employee’s doctor overseeing their care will explain the types of accommodations employees need to perform their duties. Get these details in writing so everyone can stay on the same page.

Fault Rarely Matters When Filing a Claim

A common misconception many business owners have about workers’ compensation is that employees are only eligible if their injury is due to the employer’s negligence. The truth is that fault doesn’t influence workers’ comp claims as much as you might think.

Whether an employee caused their own injuries or the employer failed to monitor the situation leading to the accident doesn’t matter. Workers’ compensation insurance will cover the cost of the damages.

The only time that fault matters is when an employee does something that impacts their ability to perform their duties. This includes drinking on the job, coming to work high, or getting into fights with coworkers. If an employee is responsible for their injuries because of these types of actions, workers’ compensation won’t kick in.

The claim will get denied and the injured employee will have to pay for their own medical expenses.

Employers Must Provide the Necessary Documentation

If an employee gets injured on the job, it’s their responsibility to notify their employer. Ideally, you should do this as soon after the accident as possible. Report what happened to the manager and let them know that you need to seek medical treatment.

This will give them time to compile the necessary workers’ compensation documents. Responsible employers will fill out their portion of the forms and ask the injured employee to do the same when they’re able.

Once the form gets filled out, they’ll submit the paperwork to the insurance company to initiate the claims process.

If an employer doesn’t provide the paperwork, the injured employee is free to initiate the claim on their own. However, if this is the case, it’s best to speak with an attorney and let them represent your case with the employer.

This can make a huge difference when trying to initiate the claim and get the money you deserve for the injury and medical treatments you received.

Getting Legal Help Is Always an Option

If you’re injured on the job, it never hurts to speak with an attorney to discuss your case. They’ll be able to review your situation and can act on your behalf to make sure the workers’ compensation insurance provider is treating your claim fairly.

Remember, it’s in the insurance company’s best interest to deny your claim whenever they can. Once they do, they don’t have to pay out any money to cover the cost of your medical expenses. They’ll look for any excuse to deny the claim as quickly as possible.

As an injured worker, it’s your right to contest the claim decision and workers’ compensation lawyers can help. They’ll negotiate with the insurance company and make sure they’re doing everything they can to get you the money you deserve.

If your employer refuses to help with your workers’ compensation claim, your attorney can help make sure they uphold their obligations.

Just make sure to choose an attorney that gets paid on contingency. This means you only pay them for their services if you win your case. If they lose, you won’t have to spend those hard-earned savings to cover the cost of your legal fees.

Workers’ Comp Doesn’t Cover Everything

Unfortunately, workers’ comp doesn’t cover every possible incident in the workplace. If you’re injured as a result of horseplay or slip and fall while entering the business for personal reasons, you’ll have to pay for your injuries on your own.

The claims are only valid for work-related injuries caused by genuine accidents. Injuries sustained because an employee wanted to get out of working are not covered by the insurance.

Additionally, workers’ comp coverage only applies to physical injuries, not mental or emotional injuries. That said, if an employee develops PTSD as a result of a physical injury received on the job, the insurance will help pay for treatment.

As long as the injury can get tied to work-related duties, it’s protected under workers’ compensation.

Employers Still Have Obligations

Once an employer files a claim, they’re still responsible for helping the employee as they can. This means trying to make sure the injured employee’s job is still open when they return. Employers must also be willing to make accommodations to help the employee come back to work as soon as possible.

Employers also can’t punish you for filing a claim even if you receive compensation for your injuries. They also can’t demote you or cut your pay as a result of the claim. If they do, it’s best to speak with workers’ compensation lawyers to discuss your concerns.

Workers’ Compensation Doesn’t Have to Be Confusing

Whether you’re a business owner or an employee, one thing is for sure: workers’ compensation is complex and can be confusing. Just remember that the coverage is in place to protect both business owners and their employees in the event of an injury.

Use the coverage as needed and don’t hesitate to file a claim when an injury happens. That’s why the insurance exists and using it is in everyone’s best interest.

Workers’ compensation coverage is just one of the types of insurance that business owners need to be successful. If you’re not sure what types of policies are best for your company, check out our latest posts for more guidance.